- Messages
- 2,705
- Type of diabetes
- Type 2
- Treatment type
- Tablets (oral)
As a t2 non insulin dependent diabetic, I have been controlling my levels with a target of keeping my hba1c as low as possible, as I understood that this would improve my risk of avoiding the most common diabetic complications.
A non diabetic Hba1c was my initial target for reasons that appeared self evident to me. If I can keep my levels the same as a non diabetic then hopefully I am also keeping the risks I am facing down to a similar level as well.
But the non diabetic hba1c range stretches from 4% to 6% so it is quite a wide range. Where within this should i/we actually be aiming for?
I am currently waiting for my latest score but my last hba1c was a non diabetic 5,2% or 33mmol/mol, which led me to question where I go from here.
Do I continue to aim lower hoping perhaps to break into the 4% club with a sub 5% hba1c?
Is there any evidence that such a score is better than my current score or even a slightly higher score?
Conversely, is there evidence that such a low score my actually be an indicator of increased rather than decreased risk of health complications.
My concerns were compounded by reading stories of other non insulin dependent t2s that on recent visits to their doctors were advised to raise their hba1c scores from under 6% (42.1 mmol/mol) to the 6-6,5% (42,1-47,5) pre diabetic range. Advise that did not make sense to me but which I did not immediately dismiss because I am not a doctor and they are, so they must be basing it on some kind of evidence and research.
Which led me to start looking online for relevant literature.
The first question I tried to find the answer to was where within the normal non diabetic range did most non diabetics lie.
I could not find a direct answer to my question but from the sample used in this relevant study
http://www.nejm.org/doi/full/10.1056/NEJMoa0908359#discussion
I got this diagram suggesting that the vast majority of non diabetics have an hba1c higher than 5% (31,1 mmol/mol) with most being in the 5-5,5% band. ( 31.1 - 36.6 mmol/mol)
But this study was based on a sample of about 11000 participants who were mainly in their fifties.
By looking at the sample characteristics of this study of 14000 non diabetics
http://m.circoutcomes.ahajournals.org/content/3/6/661.full
I got a similar looking graph
The split seemed to be 75:25 in favor of above 5%( 31,1 mmol/mol) Hba1c amongst the participating diabetics, with the 5,0-5,5 ( 31.1-36.6 mmol/mol) band again being the most populous.
So it seems that if the above is correct the average non diabetic has an hba1c of 5-5,5. ( 31.1-36.6 mmol/mol).
But does most common equate to best. What if a smaller number of diabetics had a sub 5% (31.1 mmol) hba1c but these were the non diabetics that faced the least risk.
Two diagrams extracted from these two studies gave similar answers to the above question.
Both suggest a j shape relationship between all cause mortality and Hba1c I.e the risk of death from any cause decreases with decreasing hba1c as one reduces from the diabetic to the prediabetic to the non diabetic range. But at some point around the 5% 31.1 mmol/mol) mark reducing further actually seems to increase all purpose mortality risk.
Why this should be so I can not answer but this is what I understand from the above studies/graphs.
And both of these are dealing with non diabetics who can achieve these scores without resorting to any intervention whether dietary or medicinal.
I also found this online abstract
http://m.care.diabetesjournals.org/content/early/2014/11/13/dc14-1787.abstract
From a recent German study which concluded that "Excess mortality risk is associated with both known diabetes and undiagnosed diabetes but not for prediabetes, with lowest risk at HbA1c levels 5.4–5.6% (35.5-37.7 mmol/mol) (and a significantly increased risk at ≤5.0% (31.1 mmol) and ≥6.4% ( 46.4 mmol)"
All food for thought and all challenging my basic assumption that lower is necessarily better when it comes to Hba1c
Pavlos
A non diabetic Hba1c was my initial target for reasons that appeared self evident to me. If I can keep my levels the same as a non diabetic then hopefully I am also keeping the risks I am facing down to a similar level as well.
But the non diabetic hba1c range stretches from 4% to 6% so it is quite a wide range. Where within this should i/we actually be aiming for?
I am currently waiting for my latest score but my last hba1c was a non diabetic 5,2% or 33mmol/mol, which led me to question where I go from here.
Do I continue to aim lower hoping perhaps to break into the 4% club with a sub 5% hba1c?
Is there any evidence that such a score is better than my current score or even a slightly higher score?
Conversely, is there evidence that such a low score my actually be an indicator of increased rather than decreased risk of health complications.
My concerns were compounded by reading stories of other non insulin dependent t2s that on recent visits to their doctors were advised to raise their hba1c scores from under 6% (42.1 mmol/mol) to the 6-6,5% (42,1-47,5) pre diabetic range. Advise that did not make sense to me but which I did not immediately dismiss because I am not a doctor and they are, so they must be basing it on some kind of evidence and research.
Which led me to start looking online for relevant literature.
The first question I tried to find the answer to was where within the normal non diabetic range did most non diabetics lie.
I could not find a direct answer to my question but from the sample used in this relevant study
http://www.nejm.org/doi/full/10.1056/NEJMoa0908359#discussion
I got this diagram suggesting that the vast majority of non diabetics have an hba1c higher than 5% (31,1 mmol/mol) with most being in the 5-5,5% band. ( 31.1 - 36.6 mmol/mol)
But this study was based on a sample of about 11000 participants who were mainly in their fifties.
By looking at the sample characteristics of this study of 14000 non diabetics
http://m.circoutcomes.ahajournals.org/content/3/6/661.full
I got a similar looking graph
The split seemed to be 75:25 in favor of above 5%( 31,1 mmol/mol) Hba1c amongst the participating diabetics, with the 5,0-5,5 ( 31.1-36.6 mmol/mol) band again being the most populous.
So it seems that if the above is correct the average non diabetic has an hba1c of 5-5,5. ( 31.1-36.6 mmol/mol).
But does most common equate to best. What if a smaller number of diabetics had a sub 5% (31.1 mmol) hba1c but these were the non diabetics that faced the least risk.
Two diagrams extracted from these two studies gave similar answers to the above question.
Both suggest a j shape relationship between all cause mortality and Hba1c I.e the risk of death from any cause decreases with decreasing hba1c as one reduces from the diabetic to the prediabetic to the non diabetic range. But at some point around the 5% 31.1 mmol/mol) mark reducing further actually seems to increase all purpose mortality risk.
Why this should be so I can not answer but this is what I understand from the above studies/graphs.
And both of these are dealing with non diabetics who can achieve these scores without resorting to any intervention whether dietary or medicinal.
I also found this online abstract
http://m.care.diabetesjournals.org/content/early/2014/11/13/dc14-1787.abstract
From a recent German study which concluded that "Excess mortality risk is associated with both known diabetes and undiagnosed diabetes but not for prediabetes, with lowest risk at HbA1c levels 5.4–5.6% (35.5-37.7 mmol/mol) (and a significantly increased risk at ≤5.0% (31.1 mmol) and ≥6.4% ( 46.4 mmol)"
All food for thought and all challenging my basic assumption that lower is necessarily better when it comes to Hba1c
Pavlos
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